BILL NUMBER: AB 2327	CHAPTERED  07/19/00

	CHAPTER   139
	FILED WITH SECRETARY OF STATE   JULY 19, 2000
	APPROVED BY GOVERNOR   JULY 19, 2000
	PASSED THE SENATE   JULY 6, 2000
	PASSED THE ASSEMBLY   JULY 6, 2000
	AMENDED IN SENATE   JULY 5, 2000
	AMENDED IN SENATE   JUNE 13, 2000
	AMENDED IN ASSEMBLY   APRIL 13, 2000

INTRODUCED BY   Assembly Member Gallegos

                        FEBRUARY 24, 2000

   An act to add and repeal Part 1.86 (commencing with Section
444.20) of Division 1 of the Health and Safety Code, and to repeal
Sections 1 and 2 of Chapter 47 of the Statutes of 1998, relating to
health care coverage, and declaring the urgency thereof, to take
effect immediately.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 2327, Gallegos.  Health care coverage:  consumer information
programs: confidentiality of communications.
   Existing law, until June 30, 2000, provides certain immunities and
confidentiality protections for communications of representatives of
a pilot program known as the Health Care Consumers' Information and
Assistance Program with health care consumers and certain other
persons, as specified.  Existing law also provides that the records
and files of the pilot program shall remain confidential, except as
specified.
   This bill would repeal these provisions and enact other, similar
provisions applicable to the Health Rights Hotline program.  This
bill would also enact certain related provisions applicable both to
the Health Rights Hotline program as well as local Health Consumer
Alliance programs.  The provisions that would be enacted by this act
would only be operative until December 31, 2003.
   This bill would declare that it is to take effect immediately as
an urgency statute.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  Section 1 of Chapter 47 of the Statutes of 1998 is
repealed.
  SEC. 2.  Section 2 of Chapter 47 of the Statutes of 1998 is
repealed.
  SEC. 3.  Part 1.86 (commencing with Section 444.20) is added to the
Health and Safety Code, to read:

      PART 1.86.  HEALTH CARE CONSUMER ASSISTANCE PROGRAMS

   444.20.  The Legislature finds and declares all of the following:

   (a) The health care delivery system continues to undergo rapid and
dramatic change.  Health care services are provided by a variety of
managed care structures, including health maintenance organizations
(HMOs), preferred provider organizations (PPOs), and an array of
hybrid models that have elements of traditional fee-for-service and
indemnity systems while applying managed care's utilization
management, gatekeeper, and case management techniques.  As a result
of these changes, many consumers are confused about how managed care
works or have problems navigating the health care system.
   (b) The duties of the newly established Office of Patient Advocate
within the Department of Managed Care include coordinating and
working with other governmental and nongovernmental patient
assistance programs and health care ombudsprograms.
   (c) The Center for Health Care Rights, an independent nonprofit
consumer organization, has established the Health Rights Hotline
(HRH) in the Sacramento area to help all health care consumers.  The
program's goals are to provide an independent source of information
and help for health care consumers, to collect needed information
regarding health care consumers' problems, and to advocate for the
improvement of the health care system for all consumers.  The program
is independent from, but works in close collaboration with, health
plans, providers, purchasers, insurance agents and brokers, consumer
groups, and regulators.  The program also works with the local Health
Insurance Counseling and Advocacy Program, which serves Medicare
beneficiaries in target communities.
   (d) The program educates consumers about their health care rights
and responsibilities.  It also assists consumers with questions about
their health plans and with specific problems through hotline and
in-person services.  In addition, the program collects and analyzes
information, generated both by consumers' use of the program and from
other sources, that can identify the strengths and weaknesses of
particular plans, provider groups, and delivery systems.  The program
has the potential of informing health plans, providers, purchasers,
consumers, regulators, and the Legislature about how independent
support can be provided to consumers in managed care.
   (e) Maintaining consumer confidence is a paramount concern in the
operation of the program.  While one vehicle to protect these
communications would be to establish attorney-client relationships
with consumers served, the program is generally not designed as a
"legal" program and it would undercut its collaborative strategy and
problemsolving orientation if assistance were required to be
positioned in a legal context.  Furthermore, it is critical that
consumers using the program are free from any retribution.
   (f) The Health Consumer Alliance (HCA), a partnership of
independent, nonprofit legal services agencies, includes six local
health consumer assistance programs in the Counties of Fresno, Los
Angeles, Orange, San Diego, San Francisco, and San Mateo.  These six
Health Consumer Centers help low-income consumers receive necessary
health care through education, training, and advocacy, and analysis
of systemic health access issues.
   (g) The Health Insurance Counseling and Advocacy Programs
(HICAPS), a network of community-based programs throughout the State
of California, assist California consumers statewide who are 60 years
of age or older, or who are Medicare beneficiaries regardless of
age.  These programs provide objective education, information,
counseling and assistance regarding Medicare, managed care, health
and long-term care related life and disability insurance, and related
health care coverage plans.
   444.21.  (a) All communications between a representative of the
program described in subdivision (c) of Section 444.20 and a
subscriber or enrollee, or agent of the subscriber or enrollee, or
any other recipient of health care services or any individual
assisting the recipient of health care services, seeking assistance
regarding a grievance or complaint, if reasonably related to the
requirements of the representative's responsibilities for the
program, and done in good faith, shall be privileged subject to
Division 8 (commencing with Section 900) of the Evidence Code.  The
subscriber, enrollee, or other recipient of health care services
shall be the holder of the privilege and may refuse to disclose, and
may prevent others from disclosing, a communication described in this
subdivision.  Any communication described in this subdivision shall
be a privileged communication, which shall serve as a defense to any
civil action in libel or slander against any of the persons described
in this subdivision.
   (b) All records and files of a program described in subdivision
(c) of Section 444.20 relating to any complaint or request for
assistance regarding a subscriber or enrollee, or any other recipient
of health care services, and their identity, shall remain
confidential, and shall not be subject to discovery, unless
disclosure is authorized by the subscriber or enrollee, or any other
recipient of health care services, or his or her legal
representative.  No disclosures shall be made outside of the program
without the consent of the subscriber or enrollee, or any other
recipient of health care services, that is the subject of the record
or file, unless disclosure is made without disclosing the identity of
that individual.
   (c) Any representative of the program described in subdivision (c)
of Section 444.20 shall be exempt from being required to testify in
court as to any communications described in subdivision (a) except as
the court may deem necessary to fulfill the purposes of the program.

   (d) Nothing in this section shall affect the right of a person or
entity to discover if the communication was not done in good faith
pursuant to an in camera inspection of the communication by a court.

   444.22.  (a) The Legislature recognizes that the Health Rights
Hotline, serving the greater Sacramento area, and the local Health
Consumer Alliance (HCA) programs serving the Counties of Fresno, Los
Angeles, Orange, San Diego, San Francisco, and San Mateo, provide
needed education and assistance to individual consumers and provide
the public with critical information about the health care system and
how consumers can best be assisted.  While most of their financial
support is from private sources, the programs serve an important
public interest, as do the HICAPS which statewide serve California
Medicare beneficiaries and Californians 60 years of age or older.
   (b) No discriminatory, disciplinary, or retaliatory action shall
be taken against any health facility, health care service plan,
provider, or an employee thereof, or any subscriber, enrollee, or
agent of the subscriber or enrollee, or any other recipient of health
care services or individual assisting the recipient of health care
services, if the communication is made to a program described in
subdivision (a) regarding a grievance or complaint and is intended to
assist the program in carrying out its duties and responsibilities,
unless the action was done maliciously or without good faith.  This
subdivision is not intended to allow for the unapproved release of
confidential or proprietary information by an employee or contractor,
or to otherwise infringe on the rights of an employer to supervise,
discipline, or terminate an employee for other reasons.
   444.23.  (a) Nothing in this part shall be construed to limit the
authority and ability of the California Department of Aging or its
contractors, or the direct service providers of the Health Insurance
Counseling and Advocacy Program (HICAP), from accessing, monitoring,
or reviewing case files and records developed by, or for, any
components of these programs that contractually act as a HICAP
provider.  For those programs, all case records and files of HICAP
clients are, and shall remain, the property of HICAP, subject to case
file and record retention and disposal requirements established by
the Department of Aging.  For the purposes of this section, "HICAP
clients" are defined as those accepted, initiated, and undertaken on
behalf of consumers and clients who are 60 years of age or older,
Medicare beneficiaries regardless of age, or their legal
representatives.
   (b) Nothing in this part shall be construed to limit the ability
of the subscriber or enrollee, or any other recipient of health care
services, to waive the privileges and protections provided by this
section for the purpose of providing information to a regulatory
agency, including, but not limited to, the Department of
Corporations, the Department of Managed Care, and the Department of
Insurance.
   (c) Nothing in this part shall be construed to supercede the
procedures set forth in Sections 1368, 1368.01, 1368.02, and 1368.03,
when the programs are providing assistance to a subscriber or
enrollee in connection with a complaint against a health care service
plan.
   (d) For purposes of this part, a health care service plan,
provider, subscriber, or enrollee shall have the same meaning as set
forth in Section 1345, an agent of a subscriber or enrollee shall
have the same meaning as set forth in subdivision (b) of Section
1368, and a health facility shall have the same meaning as set forth
in Section 1250.
   444.24.  This part shall remain in effect only until December 31,
2003, and as of that date is repealed, unless a later enacted
statute, that is enacted before December 31, 2003, deletes or extends
that date. Notwithstanding this date of repeal, the privileges and
protections provided under this part shall continue to apply to any
actions taken or materials collected after December 31, 2003, if they
relate to communications or actions made on or before December 31,
2003.
  SEC. 4.  All references in this act to the Department of Managed
Care shall be deemed to refer to the Department of Managed Health
Care if legislation is enacted to change the name of the department
in that manner.
  SEC. 5.   This act is an urgency statute necessary for the
immediate preservation of the public peace, health, or safety within
the meaning of Article IV of the Constitution and shall go into
immediate effect.  The facts constituting the necessity are:
   In order to continue to make confidentiality protections available
for communications between patients and representatives of nonprofit
programs to assist patients to resolve concerns about their health
care plans, it is necessary that this act take effect immediately.
